Case Report
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World J Gastroenterol. Feb 14, 2013; 19(6): 951-954
Published online Feb 14, 2013. doi: 10.3748/wjg.v19.i6.951
Successful balloon-occluded retrograde transvenous obliteration for bleeding duodenal varices using cyanoacrylate
Rintaro Hashimoto, Keitaro Sofue, Yoshito Takeuchi, Kentaro Shibamoto, Yasuaki Arai
Rintaro Hashimoto, Keitaro Sofue, Yoshito Takeuchi, Kentaro Shibamoto, Yasuaki Arai, Department of Diagnostic Radiology, National Cancer Center Central Hospital, Tokyo 104-0045, Japan
Author contributions: Hashimoto R wrote the manuscript and performed additional data analysis; Sofue K wrote the manuscript and revised it critically for important intellectual content; Takeuchi Y and Shibamoto K performed procedures; and Arai Y helped by final approval of the version to be published.
Correspondence to: Keitaro Sofue, MD, Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. keitarosofue@yahoo.co.jp
Telephone: +81-3-35422511 Fax: +81-3-35475989
Received: August 19, 2012
Revised: September 11, 2012
Accepted: October 30, 2012
Published online: February 14, 2013
Processing time: 182 Days and 12.2 Hours
Abstract

A 76-year-old woman with hepatitis C cirrhosis presented with tarry stools and hematemesis. An endoscopy demonstrated bleeding duodenal varices in the second portion of the duodenum. Contrast-enhanced computed tomography revealed markedly tortuous varices around the wall in the duodenum. Several afferent veins appeared to have developed, and the right ovarian vein draining into the inferior vena cava was detected as an efferent vein. Balloon-occluded retrograde transvenous obliteration (BRTO) of the varices using cyanoacrylate was successfully performed in combination with the temporary occlusion of the portal vein. Although no previous publications have used cyanoacrylate as an embolic agent for BRTO to control bleeding duodenal varices, this strategy can be considered as an alternative procedure to conventional BRTO using ethanolamine oleate when numerous afferent vessels that cannot be embolized are present.

Keywords: Bleeding duodenal varices; Balloon-occluded retrograde transvenous obliteration; Cyanoacrylate; Combination therapy; Temporary portal vein occlusion